Wednesday, October 2, 2013

Virus Killer: Cold and Flu Formula


Where's my Virus Killer?!
Ingredients:
Lomatium root
Blue vervain herb in flower
Chuan xin lian – andrographis herb
Yarrow leaf and flower
Elecampane root
Pu gong ying – dandelion root and herb
Niu bang zi – burdock seed
Jing jie – schizonepeta herb
Sheng gan cao – licorice root
Poke root
Ethanol
Water

Effects:
Reduce or eliminate symptoms of cold and flu, especially fever, sore throat, cough, and body aches.  Virus Killer should also be considered for ear infections, staph or strep infections, herpes, shigellosis, and most other illnesses in which a viral or bacterial origin is suspected.  NOTE: this formula is for TREATING cold and flu; don’t take it long-term to try to avoid getting sick.  The formula to strengthen the immune system to AVOID cold and flu is Jade Defense REISHI.

Dosage:
The best way to take this formula is at the very start of a cold, in combination with steam inhalation.  So, when you first start feeling like you might be getting sick, don’t shrug it off and go to bed!  Take some Virus Killer and do fifteen minutes on your Kaz brand personal steam inhaler, inhaling deeply through the nose so that the heat of the steam weakens the virus’ ability to adhere to your mucus membranes.  Repeat the next morning.

First couple days: take six squirts of Virus Killer every three hours.
Next few days: even if you are asymptomatic, take four squirts of Virus Killer every eight hours (three times a day).  This is important, as colds can come roaring back after first appearing to go away, if you don’t continue with the herbs.  Sometimes a virus is just too strong and will successfully resist your attempts at killing it.  Even so, don’t give in and stop taking your herbs.  Virus Killer can shorten the duration and intensity of a cold or flu.
This is one formula that I recommend NOT squirting into boiling water to boil off the alcohol.  Many of the active compounds are aromatics that you want to get into YOU, not into the air.  Take it straight up or cut with cold water.


Product Description:
This is an original formulation that has been in research and development for the last year or so.  Its three main actions are antiviral, diaphoretic (makes you sweat), and expectorant.

The largest component of the formula consists of the three main antiviral herbs: lomatium, blue vervain, and andrographis.  Lomatium dissectum, a large-rooted plant growing throughout the Great Basin, has been used as medicine by Native Americans and settlers for many years.  Its many aromatic resins act as an expectorant and disinfectant to the lungs and bronchi, as the body excretes them through the alveoli.  During the influenza epidemic of the early 1920’s, it was noticed that mortality among Native American groups using the herb was far lower than that of the surrounding population.

Blue vervain grows widely in our region, seeming to do fine in sunny dry dusty areas, where it stays small and compact, and thriving as a large showy plant when transplanted into gardens.  With its purple flowers that climb up its long branching spikes during the course of a summer, it is quite beautiful.  In addition to its antiviral properties, blue vervain acts as a mild sedative, diaphoretic, antispasmodic, and expectorant.  Its bitterness acts not only to clear heat but to settle the stomach.  It also helps to allay the aches and pains that often accompany the flu – especially when that pain is in the neck area.  Overall, an excellent herb when you’re sick (“the best herb for flu,” according to my teacher Brian Weissbuch).

Andrographis is an extremely bitter herb used in Chinese medicine and in Ayurveda.  Unlike blue vervain, whose bitterness I find to be pristine and bracing, andrographis' bitterness is shudder-provoking and kind of disgusting.  This makes Virus Killer one of my worst-tasting formulas.  Like lomatium, andrographis is not only antiviral but broadly antimicrobial, making it valuable in the treatment of infections of all types.

One last herb that is included as an antiviral is poke root (Phytolacca americana).  In addition to being a promising anti-cancer herb, poke includes a component known as “pokeweed antiviral protein” (PAP), making it useful against various types of viruses.  In larger doses poke root is quite toxic, and in this formula I use a near-homeopathic dosage of one drop per four-squirt dose, to stimulate the immune system.

Sometimes, herbs like lomatium and andrographis are marketed as “herbal antibiotics.”  But this approach is too simplistic.  Andrographis is so cold and bitter that, by itself, it can wreck the digestion and cause diarrhea.  Lomatium by itself can cause an outbreak of hives.  As with regular antibiotics, the use of a single intense herbal medicine can result in unwanted side effects.  It is for this reason that we craft herbal formulas: teams of herbs working together in your body to mitigate unwanted effects while maximizing the desired ones.  In the case of Virus Killer, the pairing of lomatium and andrographis is a kind of a “formula within a formula:” lomatium is warm and spicy, offsetting the cold bitter nature of the andrographis.  To make this formula even more balanced, we also add diaphoretics, additional expectorants, and a liver-stimulating diuretic.

When we get sick with a cold or flu, this signals that a pathogen has managed to get past the body’s “defensive qi,” whose job is to circulate near the surface of the body, keeping invaders out.  Therefore, we have to use diaphoretics: herbs that make us sweat.  The idea is that along with the sweat that the herbs push through our pores, the invaders are also being pushed out.  At the same time, the cooling effect of the sweat helps to lower fever.  The chief herbs that accomplish these things here are yarrow, schizonepeta, and burdock seed.  The yarrow is itself antimicrobial, adding to the pathogen-fighting power of the formula, and also pairs nicely with blue vervain to settle the stomach.  Schizonepeta (jing jie), one of the stronger diaphoretics in Chinese medicine, is useful not just for colds but for skin rashes of many types, a trait shared with burdock seed (niu bang zi).  My belief is that the surface-relieving power of these diaphoretics helps to dissipate any tendency towards hives that the lomatium could bring out in sensitive individuals.  Burdock seed is also one of the main herbs for sore throat, one of the most annoying early symptoms of cold and flu.

In addition to diaphoretics, we add herbal expectorants to the mix.  The main one here is elecampane root.  Like lomatium, elecampane is rich with resins that help to disinfect and dislodge mucus in the lungs.  Because of the tendency of cold and flu viruses to settle in the lungs, it is extremely important not just to kill the virus but to moisten and clear the lungs.  Elecampane and licorice are both excellent herbs to do this.  Licorice has the added benefit of helping the burdock seed treat sore throat.

Finally, dandelion stands alone as a strong diuretic and stimulant to liver metabolism.  Following Michael Moore, I believe that we need to support the liver during the active phase of cold and flu treatment.  Just as dead bloodied bodies can clog the landscape after a big battle, our bodies can get clogged with the junk that accompanies viral die-off.  The expectorants help move this junk out of the lungs, and the diaphoretics help move it out the skin, but the liver (of course with an assist from the kidneys) can help move it more directly out of the blood and into the urine, with which it leaves the body.  In a similar vein, by enhancing liver function, dandelion lessens the probability that you will develop hives from the sometimes-metabolically-problematical lomatium.  Dandelion also pairs well with andrographis to “relieve heat and toxicity” and treat infections.

Production Notes:
The blue vervain, yarrow, dandelion, and poke root were extracted as fresh tinctures using 70 – 95% ethanol.  The remaining herbs were purchased dried, then were ground and percolated with 50 – 60% ethanol.  Overall strength is about 1:4.  Lately I have been using a larger volume of solvent to percolate, feeling that it is wasteful to not extract every last bit of good out of the herbs (even with a good press, I have this inkling that thar’s some good stuff left in them dregs).  I’ve also been experimenting with hot percolation, heating the solvent to the boiling point of ethanol just prior to percolation.

Why Are There No Herbs for Stuffy Nose In This Formula?
Yes, that stuffy drippy nose is another bothersome symptoms of many colds and flu.  However, I believe that drying out the nose and sinuses too early in the progression of a cold is not a good thing.  The reason for the copious snot output in the first place is precisely to help your body flush out the virus.  If you follow my advice and do the steam inhalation at the first signs of infection, you may find that the steam precipitates a bout of sneezing and nose-blowing that hastens the nasal/sinus phase of the cold and gets it over within twenty minutes.  If, despite steaming and Virus Killer you end up with a stuffed up or runny nose, give it a few days and then combine with (or switch to) Nasal/Sinus Formula.  In my experience, Nasal/Sinus Formula is great for allergies and for the tail end of a cold, but not for the start of a cold.  Some saline flushing (neti pot) will also help move the mucus out of your nose and sinuses.

Wednesday, July 17, 2013

My Summer

Pumpkin, with small cup for size comparison
It's been so long since I've posted that I actually started feeling a little guilty.  The truth of the matter is is that I've gotten a little bored with writing about herb formulas.  Plus the fact that my extract pharmacy has grown to over sixty herb extracts, so I'm more in the habit of whipping up custom formulas as the need arises (not that I don't keep the favorites in stock - allergy formula, cold/flu formula, perimenopausal formula, pain formula, cancer support formula, etc. - so feel free to contact me if you are interested in purchasing some).  But most of all, the main reason I haven't been writing is that I've been having too much fun!  Let me tell you about my summer so far:

It started off with a zero-gravity chair that my wonderful wife Annette gave me for my birthday.  Have you ever tried one of these things?  You sit down in it, then the thing stretches out and back and you are suspended like an astronaut in space. It's so comfortable that you really don't want to do anything else!  It has become an indispensable part of my daily heliotherapy practice.

Annette and Kaz in Big Sur
One of the best things about summer is that it's when my daughter Sara comes home from college and we get to be with her more than a few days at a time.  So it's been great hanging out with her, going to the river, hiking, having the whole family back together again.  Earlier in the summer, she and Dylan and I made a large batch of kimchi-style pickles that we called We Qi (Kimchi!  No, it's Kaz Qi!  No, we're all making it so it's We Qi!), some of which they then took on their trip to Montana.  Lukas of course is on summer vacation too, which he is enjoying to the max - getting to sleep in, playing on the Xbox with friends, going to the beach, animating, etc.  Annette and I continue to be the working shlubbs who support all this leisure activity going on around us.  Well, I shouldn't complain too hard; Annette and I got to get away for a few days in June to celebrate our 25th anniversary with a trip to Big Sur, which was really wonderful (ah, the Gorge!  The coast!  The purple sand!  Deetjen's!  Hot tub!).  Plus, after my busiest month ever in June my practice has hit a predictable summer slump, giving me all the more time to work in the garden.

Speaking of which, my garden has been super-prolific.  The star of the season is a volunteer pumpkin plant who picked the perfect spot to sprout and has since taken over a third of the garden.  Now there are five pumpkins, the largest of which is over fifty inches around!  Our plum trees fruited like crazy this year, and for several days I was picking fifty or more plums daily, most of which I smushed and fermented in five-gallon buckets to turn into plum liquor (more on that in a minute).  Our fig tree was also more productive than ever; it seems like every year we live here it makes more fruit.  I never really liked figs that much but after tasting this sweet mild green/yellow variety, I am a convert.  I planted an artichoke for the first time ever and we have enjoyed five or six delicious pan-seared, wine-steamed artichokes so far (thank you Akemi for your splendid example of "living the dream," and the recipe).  The leaves of this plant make a strong and delicious bitter that's great for the liver and gallbladder and is an essential ingredient in my Indian Summer Bitters. What else has been growing?  Lettuce, radish, daikon, zucchinis a few pounds per week, and eight or nine tomato plants, mostly Purple Giants, who are still green and not yet giant, though promising-looking.  Finally, I have five specimens of young ashitaba - three to nibble on over the next couple years, and two to harvest at their peak in a few months to make a full-strength fresh extract.  Ashitaba is a delicious Japanese herb/vegetable that is one of the most vibrant plants I know, and good for you in so many ways.  (Thank you Darren for donating the babies!  I gave most of them away and am really enjoying the company of these five).

Herbwise, I've been busy in the field, in the garden, and in the lab.  Sara and I picked and blended some fresh gotu kola this morning.  Last week we spent the day at the river and collected hedge nettle on the way home (hedge nettle, the fuzzy "stink mint" so emblematic of our redwood forests, is a medicine I've never prepared or used before.  It's supposed to be a decent anti-inflammatory, and especially good for headaches).  A few weeks ago I distilled three cases of red wine generously donated by a patient, thus ending up with wine liquor which I keep at 45%, 75%, and 85% ethanol for various extraction and enjoyment purposes.  Currently in development: gotu kola and tulsi (holy basil) leaf and flower liqueurs.  My thinking is that gotu kola and tulsi are both excellent and delicious adaptogenic tonics that would be of great benefit to my cancer patients - the gotu kola to treat or potentially prevent the debilitating peripheral neuropathy that often accompanies chemotherapy, and tulsi whose radioprotective flavonoids show promise in protecting healthy cells during radiation.  Plus, especially if you're already swallowing tons of pills each day, what better way to take your herbs than a yummy end-of-the-day schnaps!

Earlier this week I distilled the ten gallons of fermented plums, and tomorrow is a Ladle Day so I will superstitiously and auspiciously distill it a second time to clean it up for final bottling.  Part of the resultant plum liquor will be used to make a new product I intend to call Plum3 ("plum cubed"): fresh plums macerated in plum liquor for half a year, then distilling the liqueur-soaked plums and adding the distillate back to the liqueur for intense full-spectrum plumminess.  Mmm... I can hardly wait!

Still ahead: Pico Blanco backpacking trip with buddy Andy in ten days, on which I will dig my annual supply of aralia root, then family vacation to the Mendocino coast.


Thursday, January 24, 2013

KICK CANCER: Herbal Support During Chemo and Radiation


Introduction and Disclaimer:
I have been treating cancer patients for some years now, and, for the most part, have used acupuncture as my primary modality.  The reason for this is that some of the oncologists and medical doctors that I work with and who refer patients to me are very uncomfortable about mixing herbs with chemotherapy and with Western medicine generally.  I accepted their conservatism in this regard, since herb-drug interactions are not well-understood and theoretically there is a possibility of doing harm by mixing herbs with drugs.  So I would use only acupuncture to treat my patients for their neuropathy, or their Tamoxifen-related joint pain, or whatever. 

More recently I have changed my thinking on this topic.  In China, oncologists have been combining herbs with conventional cancer therapy for decades, to good effect.  There is an entire branch of herbal medicine, called fu zheng therapy, that utilizes herbs to strengthen the patient and minimize side effects during chemo and radiation.  To disregard the clinical experience of thousands of Chinese doctors and their patients when it comes to optimizing outcomes and minimizing side effects during cancer treatment seems kind of crazy to me.  And for Western doctors to dismiss this accumulated knowledge and experience is arrogant and patronizing.

So, for my patients who wish to integrate herbal medicine into their cancer care, I have crafted this modified fu zheng formula.  About half the herbs here are Chinese herbs that research has shown to boost the immune system, regulate blood counts, etc., during cancer treatment.  The remaining herbs are plants that have a history of use as anti-cancer herbs.  After all, why stop at treating side effects?  I recently lost a patient, a patient who had become a dear friend, to brain cancer.  After she died, I had to do some deep and painful soul-searching.  What kind of physician was I, if I had not done everything in my power to prolong her life? After she died, I vowed to make available to my patients my best-bet formula not just to get them through their cancer treatment, but to try to eliminate their cancer altogether.

Please note that, despite the promise of its name, I am not claiming that this formula cures cancer.  I find nothing more despicable than companies and websites that prey on the desperation of cancer patients to sell dubious products cloaked in glowing claims and effusive testimonies.  What I DO want to offer is high-quality herbal support, and also to place a positive mental suggestion in my patient’s mind every time they take their herbs.  Kick Cancer!  Mobilize every resource you have available to do it!  Don’t give in to depressing statistics, genomic determinism, and feelings of powerlessness or hopelessness.  Positive attitude, a loving support network, healthy diet, rest and exercise, regular acupuncture or bodywork – these are all ways to nudge your body to overcome cancer.  As far as I’m concerned, the anti-cancer herbs are just one more nudge to the system, one more lever to push to urge your body to optimize and mobilize and beat this thing.  It is my deep and fervent desire that all these nudges do their job and leave my patients cancer-free.

Ingredients:
Huang qi – Astragalus membranaceus root
Ling zhi – Ganoderma lucidum fruiting body
Bai zhu – Atractylodes macrocephala rhizome
Nu zhen zi – Ligustrum lucidum fruit
Ji xue teng – Millettia dielsiana root and vine
Burdock – Arctium lappa root (fresh)
Dandelion – Taraxacum officinale entire plant (fresh)
Dokudami – Houttuynia cordata herb (fresh)
Ashitaba – Angelica keiskei leaf (fresh)
Pau d’arco – Tabebuia impetiginosa bark
Gotu kola – Centella asiatica leaf and stem (fresh)
Sheng jiang – Zingiber officinale root (fresh)
Ban xia – Pinellia ternata rhizome (treated)
Sheng gan cao – Glycyrrhiza uralensis root
Ethanol
Water

Effects:
Boost immune system, allay fatigue, stabilize white and red blood cell levels, reduce or eliminate nausea and vomiting, prevent or minimize allergic skin rashes.  This formula also contains herbs that have a long tradition of use in treating cancer.  Though the formula was designed for patients in active treatment, it is also recommended for patients with cancer who are not currently undergoing chemo or radiation.

Dosage:
Four full squirts of the dropper, twice a day.  I recommend squirting the tincture in a cup of boiling water, to boil off most of the alcohol before drinking it and to minimize the harshness of the alcohol before putting it into what may be your already chemo-irritated mouth.  Make sure to shake the bottle each time to distribute the abundant astragalus and reishi polysaccharides, which will have settled to the bottom of the bottle.  Finally, if you are currently undergoing chemotherapy, don’t take any herbs on the day of chemo, to minimize the potential for herb-drug interactions.

If after a couple weeks of use you don’t notice any change in how you are feeling, feel free to increase your dose from four squirts to six or even seven or eight. Some people will require a higher dose to see effects.  Also, chemotherapeutic agents can be so toxic that any positive biological effect of the herbs is trumped by the negative side-effects of chemo.  This isn’t necessarily a reason to discontinue the herbs, since they will continue to protect your healthy cells, detoxify your liver, benefit your circulation, etc. even if you’re not feeling great.

Product Description:
The astute reader of this blog will have noticed that the three herbs huang qi (astragalus), bai zhu (atractylodes), and ling zhi (ganoderma/reishi), are the chief herbs in my fall/winter tonic, Jade Defense REISHI. Indeed, this overlap is not accidental.  Just as it is important to boost the qi and mobilize the immune system to keep from catching colds, it is important to do these things to stay strong during cancer treatment.  From a biomedical perspective, these herbs increase interferon levels, boost white blood cell count, mobilize the immune system, and protect healthy cells from radiation damage.  They also help to increase appetite and energy.  In addition to their palliative and supportive effects, it is important to remember that astragalus and reishi polysaccharides also have anti-tumor effects as well.

In fu zheng therapy, it is considered important to tonify the blood and yin as well as the qi.  Nu zhen zi (ligustrum) and ji xue teng (millettia) are the main herbs that accomplish this.  These herbs help to keep white and red blood cell counts up, and the ji xue teng also helps combat damage to the microcirculation that occurs with some chemo agents and which can lead to peripheral neuropathy.  I would ordinarily include dang gui (Chinese angelica root) here because it is a great blood tonic, but have excluded it because its potential estrogenic effects are contraindicated in some cancers.

Burdock and dandelion is a traditional pairing often used by Western herbalists to treat cancer.  They are both cooling and detoxifying; cancer is thought of in many traditional medical systems as a disorder of heat and toxicity, and burdock and dandelion treat both.  Dokudami (houttuynia) and ashitaba (Japanese angelica leaf) are similarly used in Japanese folk medicine as anti-cancer herbs.  They are two of my favorite herbs to eat fresh (I grow them in my garden).  Speaking of which, the burdock, dandelion, dokudami, and ashitaba were all tinctured fresh, meaning that they were extracted at the peak of freshness from live plants rather than from dried plants.  It is my belief that fresh-tinctured herbs have a stronger vitality than medicines made from dry herbs.

The gotu kola (centella) in this formula is also home-grown and fresh-tinctured.  I include it here mostly for its neuroprotective, circulation-stimulating, and skin-healing effects.  My hope is that it will help prevent peripheral neuropathy and skin rashes due to chemo.  For the former effect it combines well with the ji xue teng; for the latter with the burdock and dandelion.

Pau d’arco (tabebuia) is the final anti-cancer herb in the formula.  It has a long tradition of use in South America, mostly for skin problems, autoimmune disorders, and cancer.

Sheng jiang (fresh ginger) and ban xia (pinellia) are included for their anti-nausea effects.  They work well with the huang qi and bai zhu to strengthen and protect the stomach to prevent nausea.  The final herb in the mix, gan cao (licorice), is added to harmonize the formula – its job is to make all the other ingredients get along and work well together as a team. Licorice is an important detoxifying herb in its own right; the compound in it known as glycyrrhizin is metabolized into glucoronic acid, which turns toxic non-water-soluble substance water-soluble so that they may be excreted by the body.

Production Notes:
In the past couple years I have been expanding my liquid herb pharmacy, creating ethanol/water tinctures of single herbs that I use a lot.  This is my first Green Monkey Pharmacy product made entirely by combining single herb extracts rather than extracting the formula all at once.  The astragalus and the reishi were separately extracted in a relatively large amount of pure water over low heat in order to maximize the amount of immune-stimulating polysaccharides in the final solution, then boiled down.  The remaining dry herbs were separately ground and percolated to a final strength of 1:3.  The fresh herbs were extracted with 95% ethanol for maximal extraction of alcohol- and water-soluble compounds, at 1:2 fresh-weight to alcohol ratio.  Finally, these various extracts were combined.  Because the immune-stimulating polysaccharides are water-soluble and not alcohol-soluble, about half the polysaccharide mass precipitates out of solution once the extracts are combined.  This is why you need to shake the bottle well each time you take a dose.

One Other Herb You May Want to Consider:
I recently had the opportunity to dig up the root of pokeweed, Phytolacca americana.  Poke is a beautiful and vigorous plant common in the American South and Midwest.  It was used by the Eclectic physicians in the 1800s and by Native American tribes, doubtless for much longer than that.  Its primary uses are as a lymphatic stimulant, for swollen glands, sore throat, mastitis, skin problems, arthritis, and cancer - one of its common names, "cancer jalap," reflects its folk use as a cancer remedy.  (Probably THE primary use of poke is the berry juice as pediatric face paint, but that does not concern us here).  The whole plant is extremely toxic, and the effective dose is a mere drop of tincture up to five or six drops, mixed in a glass of water and drunk two or three times a day.  A very similar plant, shang lu (Phytolacca acinosa), is used in traditional Chinese medicine primarily for its toxic effects, i.e. to cause a cathartic expulsion of stool to treat severe edema and constipation.  It is also used topically for sores and carbuncles.

Poke's toxicity is clearly problematic, as a careless patient could easily cause severe gastric upset, blood clots, coma, or even death by taking too much.  For this reason I didn’t include it in Kick Cancer.  However, the potential benefits of careful low-dose treatments in my opinion outweigh the potential dangers, and I encourage patients – especially patients who opt to forego conventional treatment – to consider a course of poke treatment.

The chemistry of pokeweed is very interesting, and more compelling than any other anti-cancer herb I know of.  The active anti-cancer component is a lectin known as pokeweed mitogen (PWM).  Lectins are antibody-like chemicals that are involved in biological recognition phenomena.  They are sugar-binding proteins that attach selectively to specific sugars that they encounter.  When those sugars are part of a cell’s molecular signature at the cell membrane, lectins cause those cells to clump.  There is some intriguing research suggesting that pokeweed mitogen has an affinity for cancer cells, signaling the immune system to then clean up the clumps and eliminate the cancerous cells.

Additionally, PWM induces cell division in B and T lymphocytes – this is what makes it a mitogen: it induces mitosis or cell division. But what is interesting is that by increasing T and B cell proliferation, PWM enhances two separate mechanisms that target cancer cells. T cells directly and indirectly kill antigenic tumor cells, and B cells are raw material for plasma cells, which develop into antibodies, which check the growth of cancer cells.

It’s kind of like a special ops team marking a target with a laser beam from a mile away, then a jetfighter swooping over and bombing the marked target.  Poke serves as both the laser-wielding special operative and the jetfighter.

The idea of purposely causing cell proliferation may sound kind of scary, since after all what is cancer if not cell division run amok?  Here I think that dosage and duration of treatment is important, and this is why I’d rather talk to you in person if you’re interested in trying it out rather than just make it part of this formula.  I am currently making an alcohol extract for careful internal use, and an oil extract for external use (for lymphatic swellings, skin cancers, and close-to-the-surface tumors, such as many breast cancers).  

It is probably simplistic to think that poke will help in all cancers, since "cancer" is actually many different diseases.  Personally, I would be wary of giving poke extract to patients with one of the blood cancers, since they are already having issues with proliferation of certain kinds of blood cells.  Poke is strong medicine, far on the pharmaceutical end of the food-to-drug spectrum on which we can place herbal medicines.  But its novel mechanism for stimulating the immune system to go after cancerous cells, and its long history of use as a cancer treatment, make me very excited to be able to offer it to you as another powerful nudge (or should I say "poke"?) to encourage your body to kick cancer.

Wednesday, September 19, 2012

New for Fall 2012: Jade Defense REISHI


Since I have written at length about Jade Defense elsewhere, I invite you to read that post if you are new to the formula or want to refresh your memory.  In today’s post I will ramble a little bit about what makes this year’s Jade Defense “new and improved.”

Extraction Method:
The first thing is that compared to last year, I got a little bit more sophisticated in my extraction technique.  I typically make my liquid extracts as a mixed water/alcohol percolation, all the herbs ground up, moistened overnight, and extracted together in one fell swoop over the course of a day.  Last year’s Jade Defense veered from that protocol in that the aralia was extracted separately with pure ethanol as a fresh plant, and also I used the reflux feature of my Soxhlet Extractor to do a second extraction of the remaining herbs without added solvent.  I was quite pleased with the outcome, and in fact caught only one cold last winter (I attribute this defeat not to a failure of Jade Defense but to my staying up too late on New Year’s Eve).

This year, based on the fact that Jade Defense packs much of its immune-stimulating punch due to the water-soluble polysaccharides in a few of its key herbs, I first performed a pure ethanol extraction of the polysaccharide-rich astragalus and ganoderma (more on the ganoderma in a minute), and the aralia as well almost as an afterthought, to pull out ethanol-soluble medicinal compounds.  Then, after pressing the dregs, I performed a low-heat water extraction of the same herbs over several hours.  Finally I combined the two extracts, with each other and with the standard ethanol/water percolation of the remaining herbs in the formula (atractylodes, Siberian Ginseng, and ledebouriella). 

The result is a murky brown fluid that, when allowed to settle, shows components of different densities forming layers and clouds of various supersaturated solutes. Some people prefer their tinctures cloudless and pristine, and in fact I usually adhere to this esthetic standard in my medicines.  But in this particular case, I don’t mind at all because the result is so worthwhile.  The parts that settle out do so not because they are somehow rendered inactive; they are simply present in too high a concentration to be held in solution by the ethanol/water mix of the final tincture.  So, to get the maximum benefit out of your polyssacharide-boosted Jade Defense, you just have to remember to shake the bottle well before you take a dose.

Dosage:
Jade Defense is a formula that should be taken long-term to build the immune system.  Last year, I fear there were people who got one two-ounce bottle, took it for two weeks, went off of it, and then got sick a few weeks later.  So, to encourage you to do it right this year, Jade Defense REISHI is being distributed in four-ounce bottles.  If you take the recommended half-teaspoon dose twice a day (in the morning and late afternoon, on an empty stomach), one bottle should last you about a month.  If you prefer using a dropper for accurate dosing, transfer some of your Jade Defense REISHI to a dropper bottle AFTER SHAKING THOROUGHLY and take an equivalent amount (this should be about four full squirts, but you should calibrate this against a half-teaspoon baker's measuring spoon to make sure).  I like to mix it with a little hot water, but it can also be enjoyed straight up or on ice.

Reishi:
The new addition to this year’s formula is a medicinal mushroom most commonly known by its Japanese name, “reishi,” which is the Japanese pronounciation of its Chinese name, “ling zhi.”  Its Latin binomial is Ganoderma lucidum.  Reishi’s 43.3 Mb genome was sequenced earlier this year, yielding fascinating new information on the fungus’ metabolic pathways that result in the over four hundred bioactive compounds it produces.

Reishi holds a special place in the world of Chinese medicine.  Since ancient times it has been revered as a medicine of almost supernatural power.  In fact, the “rei” part of “reishi” (“ling” in Chinese) is a character that means something like “miraculous,” “mysterious,” or “supernatural.”  And the “shi” part (“zhi” in Chinese”) is a special character that is not used to refer to ordinary mushrooms but to semi-divine “excrescences” that, according to Daoist scholar Fabrizio Pregadio “pertain to an intermediate dimension between mundane and transcendent reality.”

What would lead the ancient Chinese emperors and sages to hold this fungus in such high regard?  One factor was its rarity (only in recent decades has it been successfully propagated and made widely available to consumers).  Another reason is surely its health effects.  Reishi was thought to confer longevity and even immortality on its ingesters.  Finally, as with most “sacred” plants used by humans, reishi-lovers probably appreciated its effects on their state of mind.

Health:
Fortunately for us, two millennia of anecdotal evidence about reishi’s health effects are backed up by much modern research.  Reishi is easily one of the best-researched medicinal herbs in the world.  What scientists have found is that reishi’s health effects are produced by two main classes of compounds: triterpenoids and polysaccharides.

The triterpenoids in reishi are all modifications of lanosterol, which is the precursor of all steroid hormones including ergosterol, which functions in fungal cell membranes much as cholesterol does in animals. However, reishi produces more than 150 different triterpenoids, begging the question: why?  Most likely, due to their bitter flavor, at least some of these triterpenoids are useful as anti-predation chemicals (animals don’t enjoy eating them).  Others probably play different roles in fungal biology.  Over many many generations of selection, the reishi mushroom has produced a startling array of triterpenoids, which, lucky for us, exhibit a number of health effects in humans.  Chief among these are liver-protectant, anti-hypertensive, anti-cholesterol, and anti-allergy effects of a subset of triterpenoids known as ganoderic acids.

The second major class of bioactive compounds found in reishi is the polysaccharides.  These are extremely large macromolecules that form the structural matrix of the mushroom’s body.  They are the stuff that makes a mushroom rubbery/spongy, and they are also secreted by fungi and algae to help them stick to surfaces they are growing on, and to keep them from drying out.  Beta-glucans – one type of polysaccharide found in reishi as well as in yeast, some grains, and in other fungi – have been shown to have immune system stimulating effects.  It turns out that a receptor on the surface of human innate immune cells binds to beta-glucan, allowing the immune cells to recognize it as “non-self” and mount an immune response.  Because a part of these giant polysaccharides is structurally similar to signature molecules found on the cell membranes of bacteria, the body is in effect tricked into strengthening its immunity when there is in fact no actual threat.  The end result is an increased ability to fight pathogens and protect from disease. Animal studies show that beta-glucans and a number of different polysaccharides in reishi exhibit other effects, most importantly anti-tumor, radiation-protective, anti-inflammatory, and hypoglycemic effects.  While the mechanisms underlying these effects are poorly understood, I conclude that anybody wishing to strengthen their immune system, especially those fighting cancer or trying to avoid it, stand to benefit from supplementing with reishi.

Finally, drawing more from traditional therapeutic use than from contemporary research, reishi is an excellent herb for the lungs.  Like most mushrooms, it is yin-nourishing, with much of its yin-nourishing effect centered on the lungs.  This makes it useful for many kinds of cough, asthma, and bronchitis, and also makes it a good partner to the astragalus and aralia in Jade Defense, which strengthen the qi of the lungs to ward off cold and flu.

Mental Effects:
Reishi exhibits paradoxical central nervous system effects.  Some people say it energizes them, while others find it sedating and helpful for insomnia.  I believe this is because there are multiple (or at least two) substances in it with different mental effects, and that some are soluble in alcohol and others in water.  Due to the structural similarity of reishi triterpenoids to steroid hormones, it is quite likely that one or more triterpenoids are stimulating to the human nervous system much like steroids can be.  So a reishi extract that was made primarily using ethanol or another triterpenoid-friendly solvent could be expected to make you slightly wired.  Whereas other substances extracted using water may be responsible for any sedative effect.  My friend Gus used to get a dark reishi extract that was legendary for its sleepy feel-good effect (my buddy Andy Seplow has sourced some more recently that he says is comparable; if you’re interested in sleepy reishi you should contact him).

This issue suggests a future experiment in which I will separately extract reishi using alcohol and water, and evaluate each for mental effects.  I will report back once these experiments are concluded.

In the meantime, beware that THIS reishi extract that is included in Jade Defense REISHI may be stimulating to some folks.  I found this to be the case during my first week of organoleptic product testing.  I kept finding myself awake at night having all sorts of deep and interesting thoughts.  When it finally occurred to me that this was due to my evening dose of Jade Defense REISHI, I reduced my consumption to one daily morning dose, and was able to sleep again.  So if you find yourself suffering from insomnia after starting your course of Jade Defense REISHI, try taking your second dose earlier in the day, and/or reducing your second dose.  If this still doesn’t work, you can reduce your consumption to just once a day in the morning, as I have done (your stash of Jade Defense REISHI will also last twice as long!).  The jury is still out on whether the once daily dose will confer equivalent immune-stimulating benefit – I suppose we will find out this coming cold season.

NOTE:  when I say "mental effects," we're talking subtle.  These are not the magic mushrooms favored by Deadheads and other psychonauts!  I find the subjective effect of reishi to be, excuse the expression Buddhist literalists, to be very Zen: a centered alertness and creativity that keeps me feeling good and gets me through the day.

Rant:
But all this talk of steroids, triterpenes, polysaccharides, etc. kind of misses the point.  We always want to know what does what, why does this stuff work, what molecules go to what receptors and what the hell is going on here?  That’s just the way our minds work, and I think it’s great that there are people studying this stuff.  And it sure is fun tossing around words like "triterpenoid."  But what I think is even greater is that there is this mushroom that grows in the wild, that people have been ingesting for many centuries because of what it does for their health and because they like the way it makes them feel.  And it’s not only this mushroom!  There are thousands of plants and fungi and bugs and animals that have medicinal effects in humans, that people have figured out over hundreds of generations.  Why do we insist on all these scientific studies to validate this stuff?  Why don’t we trust that people got it right?  Why would they keep ingesting some yucky-tasting fungus if it didn’t do them any good?  And why wouldn't they notice what it was doing for them, and compare notes, and pass this information along?  There’s an arrogance underlying the modern skeptico-medicalist presumption that much of natural healing is just old wives’ tales.  In fact, there’s usually a good reason why old wives tell their tales and old herbalists keep using their favorite herbs. 

There’s a divestment of our own authority, and our own wisdom, if you will, when we rely on scientific studies or Dr. Oz to tell us what’s good for us.  We should instead be curious, and open, and rational and critical too, as we make our way through life eating and drinking and trying things out in our quest to be whole and healthy and happy.  How does this make you feel?  If you feel worse, stop doing it.  If it makes you feel better, maybe it’s a good thing.  Stay aware.  Use common sense.  Live in balance with the seasons.  Take it easy.  Move your body.  Eat real food.  Take herbs when necessary.  Grow them in your garden and nibble on them fresh (I'd be happy to give you a gotu kola baby or a dokudami next spring).  Generally speaking, we should be able to take care of ourselves, health-wise, and be enjoying ourselves in the process.  The underlying philosophy of Green Monkey Pharmacy is essentially one of self-reliance.  Take responsibility for your own health!  See a doctor when you have to, get your annual checkup, but for most of the rest you can take care of yourself!  Start now with Jade Defense REISHI to stay healthy through the fall and winter.

Monday, May 7, 2012

Nasal/Sinus Formula: Relief from Allergies and Congestion


Ingredients:
Chai hu – Bupleurum chinense root
Huang qin – Scutellaria baicalensis root
Ban xia – Pinellia ternata rhizome (treated)
Sheng jiang – Zingiber officinale root (fresh)
Da zao – Zisiphus jujuba fruit
Xin yi hua – Magnolia liliflora bud
Cang er zi – Xanthium sibiricum fruit
Bai zhi – Angelica dahurica root
Shi chang pu – Acorus gramineus rhizome
Jie geng – Platycodon grandiflorum root
Ju hua – Chrysanthemum morifolium flower
Ge gen – Pueraria lobata root
Sheng gan cao – Glycyrrhiza uralensis root
Pu gong ying – Taraxacum officinale root and leaf (tinctured fresh)
Water
Ethanol
Honey

Effects:
Reduce or eliminate symptoms of seasonal allergies, especially runny or stuffed nose.  Resolve long-lasting cold whose main residual symptom is stuffy nose and blocked sinus.

Dosage:
Standard dose is four full squirts of the dropper, twice a day.  For some people the standard dose is overly drying; if you find this is the case for you, try a smaller dose until you hit upon the right dose for you.  If you predictably suffer from seasonal allergies, combine with Jade Defense and begin this regimen a month or so ahead of your allergy season – three squirts Jade Defense and one squirt Nasal/Sinus Formula, twice a day.  For snotty colds and sinus infections, combine with Virus Killer (forthcoming from Green Monkey Pharmacy).  The best way to take this formula is to squirt the tincture directly into your mouth and hold it in your mouth for maximum buccal absorption so that some of the anti-allergy components in the herbs can directly enter the affected tissues of the face, bypassing the general circulation.  This is one formula that I don't recommend thinning down in boiled water; you don't want to boil off the volatile components that give it much of its anti-allergy power.

Product Description:
This formula is built on Xiao Chai Hu Tang (“Minor Bupleurum Decoction”) from the Shang Han Lun or “Treatise on Cold Damage,” one of the earliest (220 CE) and most famous books of Chinese medicine.  The original formula was designed to treat the shaoyang or “lesser yang” stage of a disease, when a pathogen has neither completely penetrated the body’s defenses nor been successfully fended off.  This “not in, not out” status describes allergies and unresolved colds, making this an ideal formula for treating both.

The original formula consists of chai hu (bupleurum), huang qin (scutellaria), ban xia (pinellia), sheng jiang (fresh ginger), ren shen (ginseng root), da zao (jujube date) and zhi gan cao (cured licorice root).  In my version I substitute dang shen (codonopsis) for ginseng and uncured licorice for cured licorice, and add a number of other herbs to make the formula more effective for nasal and sinus symptoms.  Xiao Chai Hu Tang is an energetically very interesting formula.  The main herb, chai hu, is cool and outthrusting, making it effective for clearing a pathogen (whether virus or pollen) from the in-between zone where it resides.  Chai hu also moves stagnant qi, making it a good herb for soothing the out-of-sorts feeling that an allergy or head cold can produce.  Huang qin is a major heat-clearing and dampness-drying herb that pairs nicely with chai hu to vent the pathogen in a shaoyang-type disorder.  Huang qin also pairs well with ban xia, which is one of the major herbs for treating phlegm of all types.  Interestingly, in light of its inclusion in this allergy formula, recent research shows that one of the major components of huang qin, known as baicalein, inhibits mast cells and therefore minimizes histamine release and allergy symptoms.  The remaining herbs in the original formula – sheng jiang, ren shen/dang shen, da zao, and sheng gan cao – strengthen the qi to help keep the pathogen from penetrating further.  The da zao and sheng gan cao also serve to balance the drying nature of ban xia and some of the other herbs that I add to the original formula.

Since this is a remedy for allergies and lingering colds with predominantly nasal symptoms such as stuffiness and runny nose, I have added additional herbs for this purpose.  Xin yi hua (magnolia bud), cang er zi (cocklebur), and bai zhi (angelica dahurica root) are the trinity typically employed for this purpose, to which I add shi chang pu (acorus rhizome).  Shi chang pu is traditionally used to “open the portals” of the sensory organs in heavy-duty conditions like seizures and disorientation.  In larger doses it is mildly psychoactive; in our smaller dose it serves as one more opener of the nose and sinuses.  Next year I will add silver beach bur, the local coastal ragweed, which like its other ragweed cousins is excellent for treating the very allergies its copious pollens produce in many people (as of today it hasn’t flowered yet, and I prefer the idea of using the flowering plant rather than just the foliage).

Finally, ju hua (chrysanthemum), jie geng (platycodon), ge gen (kudzu root), and fresh tincture of dandelion were added.  Ju hua addresses the itchy and dry eyes that accompany many allergies.  Jie geng together with the licorice directs the formula to the throat region, which is often itchy and irritated.  Ge gen directs the formula to the regions of the nose and sinuses, and, together with sheng gan cao and da zao, helps to offset the drying nature of the formula.  Pu gong ying (dandelion) is added not because it is an anti-allergy herb per se (although, together with the ju hua and huang qin, it is useful for hot red itchy eyes), but because it is a premier liver herb and spring is the season of the liver so it supports this organ during the season that it is most stressed.  I am not as gung ho about “detoxifying” as many in the alternative medicine community, but in this context of seasonal allergies I do believe that it is useful to add a detoxifying herb like dandelion to the mix, to make the formula work better.

Production Notes:
3.75 liters of an alcohol-water blend was slowly percolated through 1.25 kilogram of pre-moistened ground-up herbs to produce about 3 liters of tincture.  200 ml of dandelion fresh tincture was added directly to the resulting tincture.  Strength of the final tincture is about 1:2.5. 

Something Else You Can Do to Treat Allergies and Stuffy Nose:
When they find out that you suffer from allergies, about 95% of people in Santa Cruz will immediately tell you to use a neti pot.  For the small minority of readers who are unfamiliar with the neti pot, it is essentially a small pitcher designed to pour warm salt water through your nostrils to flush out your nasal passages.  Generally, I think this is good advice for people suffering from allergies, since the salty water flushes through the nasal cavity and nasopharynx where pollens and other allergens can adhere.  I prefer to use a plastic squeeze bottle rather than the traditional neti pot, since with the squeeze bottle you have the advantage of being able to force the saline through your sinuses and nasal passages with some pressure.  For colds, I find the nasal flush more useful towards the end of a stuffy-nosed cold – it’s really satisfying to see those deposits of snot getting flushed out.  In my experience, at the beginning of a stuffy-nosed cold, using the neti pot just makes me more stuffed up.  If you are new to the neti pot, have someone show you how to do it, or Google “neti pot” on the Internet – there are hundreds of people out there who are very excited to share the technique with you.

Wednesday, February 29, 2012

Cool Lady: Menopausal Hot Flash Formula


Ingredients:
Bie jia – 
Amyda sinensis turtle shell
Qing hao – 
Artemisia annua herb
Sheng di huang – 
Rehmannia glutinosa root (uncured)
Shu di huang – 
Rehmannia glutinosa root (cured)
Yin chai hu – 
Stellaria dichotoma root
Di gu pi – 
Lycium chinense bark
Han lian cao – 
Eclipta prostrata herb
Mu dan pi – 
Paeonia suffroticosa root bark
Zhi mu – 
Anemarrhena asphodeloides rhizome
Bai shao – 
Paeonia alba root
Water
Ethanol

Effects:
Eliminate or reduce perimenopausal and menopausal hot flashes and night sweats.  In Chinese medical terms, this formula primarily cools vacuity heat and secondarily nourishes the yin.  Cool Lady may also help with excessive menstrual bleeding, which is often due to too much “heat,” and there are herbs here that clear heat and stop bleeding.

Dosage:
Start with four full squirts of the dropper, twice a day.  This should eliminate or reduce your hot flashes quickly, within a matter of days.  If not, try more – five or six squirts.  Once you are feeling better, start reducing the twice-daily dose. Play around with the dosage, constantly trying to achieve your minimum effective dose.  After several weeks of being blissfully hot flash free, try weaning yourself completely and then use Cool Lady only on an as-needed basis.  I recommend thinning it down in a small glass of water, mostly because I personally can’t stand the taste of mu dan pi (tree peony root bark), which predominates.  Squirt the tincture into a cup of freshly boiled water to evaporate most of the alcohol if you wish to avoid alcohol. 

Background:
The Chinese talk a lot about yin and yang – you could say that it is the fundamental organizing principle behind all forms of classical Chinese culture, from painting to warfare to medicine.  In the human body, yin is the soft parts, the interior, the lower portion, and yang is the hard parts, the exterior, the upper portion.  Most importantly for our present purposes, yin is the watery, fluid aspect of ourselves – the ocean that we internalized when we crawled out of the sea many eons ago.  And yang is the fiery aspect – the flame of digestion, the heat of passion, the slow burn of life and growth.  Modern life is extremely yang: full force, relentless forward movement, constant stimulation and activity with too little time for the quintessential yin “activities” of sleep and rest.  The result is that we almost literally burn out, like soup that has been left on the fire too long.  Add to that the fact that both yin and yang naturally get depleted with age, and that women lose some of their yin on a monthly basis (blood is a subset of yin in the body), and you end up with a deficit of both – and for many women, a comparatively larger deficit of yin.  So, even though the yang fire is low, the yin water is even lower so the fire appears to flare.  This flaring, known as “yin vacuity fire,” can manifest as a hot flash.  What I love about this description of what’s going on in the body is that although it appears to be so poetic and metaphorical, it is actually extremely accurate and useful: the medicine that evolved from this way of thinking really works.  I would go so far as to say that this is why Chinese medicine truly shines when it comes to women’s health.  Yin-yang theory is an excellent basis for understanding much of nature, but it is especially good for diagnosing and treating women, who with their monthly cycles embody the ebb and flow of yin and yang, making them easier to treat.

Product Description:
This formula is a variation of Qing Hao Bie Jia Tang (“Artemisia and Turtle Shell Decoction”), first put down in writing in 1798 in a book on infectious disease.  The original formula was designed to treat injury to the yin in the wake of a febrile disease, with night fevers that recede in the morning.  My friend and teacher Andy Ellis first suggested to me years ago that I use it to treat hot flashes, saying it was stronger and more effective than most of the usual menopause formulas.  I’ve found him to be right!  And I am especially happy with this particular version, since it works so well.

The original formula consists of bie jia (turtle shell), qing hao (artemisia herb), sheng di huang (uncured rehmannia root), zhi mu (anemarrhena root), and mu dan pi (tree peony root bark).  The crux of this formula is the pairing of turtle shell, which is deeply yin-nourishing, with artemisia, which clears heat.  Note that this is Artemisia annua, the source of the sesquiterpene lactone artemisinin (widely used in combination malaria treatments and off-label as a cancer treatment), not the Artemisia absinthium that shows up in my home-made absinthe or the Artemisia vulgaris that I use for making moxa.  Although sheng di huang (uncured rehmannia root) and zhi mu (anemarrhena root) are considerd to be somewhat yin-nourishing, they are primarily heat-clearing herbs, as is mu dan pi (tree peony root bark), the remaining herb in the original formula.  Therefore, you can see that this formula is more about clearing the vacuity heat than it is about nourishing yin per se.

To make my version of this formula more yin-nourishing, I have added shu di huang (cured rehmannia root), which strongly nourishes the yin and the blood, and han lian cao (eclipta herb), which also tonifies the yin while at the same time clearing vacuity heat (eclipta also has the reputation, both in Chinese medicine and in Indian Ayurveda, of turning grey hair black again).  Additionally, the herbs di gu pi (lycium bark) and yin chai hu (stellaria root) are included for their specific effect of clearing yin vacuity heat.  Finally, a small amount of bai shao (peony root) is included to “preserve the yin.”  Bai shao has an astringency that hold the yin in and helps prevent night sweats.  It is also a major blood-tonifying herb that regulates the menses and smoothes the qi and blood in conditions such as abdominal pain, cramps, and all-around yuckiness-feeling.  Bai shao is one of my favorite herbs.

It is not uncommon for women to experience excessive menstrual bleeding during the transition to menopause.  This is because, as it heats up, the blood turns "reckless" and overflows.  Fortunately, many of the herbs here help stop menstrual bleeding: sheng di huang, mu dan pi, di gu pi, han lian cao, yin chai hu, and bai shao all help in some way to regulate and stop menstrual bleeding.  For this reason, this formula can be very useful not just for perimenopausal and menopausal women, but for any woman who experiences heavy periods due to heat in the blood.  It is possible to suffer from menorrhagia due to other causes, so if you are experiencing heavy menstrual bleeding with no hot flashes or other menopausal symptoms, you should get checked out by a practitioner of Chinese medicine to determine the cause of your heavy bleeding.  Or you can try some Cool Lady and, if it works, conclude that you have some sort of blood heat or yin vacuity heat going on.

Production Notes:
2.5 liters of an alcohol-water blend was slowly percolated through one kilogram of pre-moistened ground-up herbs to produce about 2 liters of tincture.  A second percolation of 500 ml. boiling water was performed to better extract the more water-soluble yin-nourishing herb constituents, and the resulting fluid was added to the main tincture.  Strength of the final tincture is 1:2.5. 

I can’t help but put in a plug here for Spring Wind Herbs, the source for most of the dried bulk herbs that go into my tinctures (and owned and run by the aforementioned Andy Ellis).  A lot of bulk Chinese herbs out there are in pretty sorry shape.  Not only is misidentification and mislabeling of herbs a problem in the industry; even if the herb is the correct plant, there’s a lot of dusty musty stuff out there whose colors and aromas are indistinct and which has probably sat in a warehouse for months, being nibbled on by rats and bugs.  Not so Spring Wind Herbs!  Opening the sealed plastic bags of Spring Wind herbs is a feast for the senses.  The qing hao in this formula is the freshest, most vibrant qing hao I’ve ever seen: so green, so fragrant!  And the mu dan pi, also so strongly aromatic (if yuckily so).  The sheng di huang and shu di huang are notoriously difficult to grind, so I was extremely pleased to be able to get them pre-ground to a fine powder (how do they do it? first freeze-dry, then grind?).  Thank you Spring Wind!

Other Considerations:
You shouldn’t rely exclusively on Cool Lady to nourish your yin and clear your heat.  Stop being so yang’d out.  Slow down.  Rest more.  Spend time communing with earth and ocean.  Incorporate more yin-nourishing foods into your diet, like seaweeds (wakame, kombu, hijiki), leafy greens, mung beans, oysters, fish, mushrooms.  Drink enough water.  Cut down on, or eliminate, things that burn the yin, like alcohol, cigarettes, and spicy fried foods.  Because Cool Lady is more heat-clearing than yin-nourishing, you may find that it gets rid of your hot flashes, but when you stop taking it the hot flashes come back.  If you follow the dosage recommendations above and find that your hot flashes return after you have weaned yourself from the herbs, you should take a more straightforwardly yin-nourishing formula such as Liu Wei Di Huang Tang (available in most natural food stores in pill form) in conjunction with Cool Lady.  Take the Liu Wei Di Huang Tang regularly and long-term, adding Cool Lady at low dose or as needed.  Cool Lady is not meant to be used long-term, as the preponderance of cooling herbs may dampen the digestive fire and end up causing loose stools or diarrhea.  If your digestion is weak to begin with, try smaller doses and take them after meals rather than before.  If this doesn’t work for you, let me know, and we can discuss herbal strategies for protecting the digestion while concurrently nourishing yin and clearing vacuity heat.